Speed and Acrobatics on the Slopes Worsening Snow Sport Injuries

Action Points

Explain to interested patients that the review supported increasing rates of head and spinal injury among skiers and particularly among snowboarders.

Inform patients that helmets can reduce risk of injury during snowboarding and skiing.

TORONTO, Dec. 4 -- Among skiers and snowboarders, higher speeds and more jumps and acrobatics are leading to a sharp rise in serious head and spinal injuries.

In one study, traumatic brain injury rose from 12% to 15% among skiers and from 1,000 to 5,200 per year among snowboarders from 1992 to 1997, according to a systematic review in the December issue of the journal Injury Prevention.

In another study, spinal cord injury skyrocketed 130% among children and 407% among adolescents over the 21-year period from 1972-73 to 1993-94.

The occurrence rate of both spinal cord and traumatic brain injury appears to be increasing worldwide because of higher speeds and more jumps and acrobatics leading to more falls and collisions, found Charles H. Tator, M.D., Ph.D., of Toronto Western Hospital here, and colleagues. However, helmets can reduce the risk of head injury by 22% to 60%, they added.

The review included retrospective reviews and epidemiological studies, whether case-control, cohort, or cross-sectional. Prospective and retrospective studies were included across languages from 1990 through 2004.

Eighteen of the 24 articles in the review focused on traumatic brain injury, but 11 looked at spinal cord injury and five reported both outcomes. Some data came from trauma registries and databases, and two death certificates and coroners' reports.

The review did not exclude less severe traumatic brain injury, such as concussion. The researchers noted that the definition of head injury has changed over the past decade with an unknown effect on incidence data.

In one report, head injuries accounted for 28% of all injuries among skiers and 33.5% among snowboarders. Most head injuries in another study were concussions (69.4%), but 14.3% were more serious brain injuries.

Fourteen of the studies included both snowboarding and skiing (one added snowblading as well) whereas six reported on injuries related only to skiing and four were restricted to snowboarding.

These studies consistently reported that snowboarders were more likely to sustain serious head or spinal injuries than skiers.

One U.S. study suggested that the odds were 66% higher for all types of injury (P=0.05) whereas a Norwegian study put the odds even higher at three- to fourfold. A Canadian study found a 50% increase in head and neck injury risk for snowboarders compared with skiers.

Younger men were particularly at risk.

Head injuries were 2.2 times more common among men than women in one study. In a study from Japan, men accounted for 63% of all snowboard injuries and 51% of all ski injuries.

Those 35 and younger were at three times the risk of head injury as older skiers and snowboarders in one study. In a Canadian study, students on school outings were 25% more likely to be injured than adults on organized outings.

Notably, a Canadian study showed that most concussions were among recreational skiers at an intermediate skill level rather than during competitions. The study also showed that risk was 2.5 times higher on ungroomed and rough snow than on soft snow.

The same trends appeared for spinal cord injury. Injuries to the spine accounted for 1% to 13% of all injuries in skiing and snowboarding with a rate of 0.01 to 0.075 per 1,000 skier or snowboarder days.

Again, men accounted for 70% of all spinal cord injuries among skiers and 100% of these injuries among snowboarders in one study.

Jumps were the main cause among snowboarders (77%) followed by falls (18%) whereas the opposite was true among skiers (59% falls and 20% jumps).

"Thus, spinal cord injury in skiers and boarders is a significant problem, especially in young male snowboarders, and is increasing with the increased risk-taking behavior occurring on the mountains," Dr. Tator and colleagues said.

Moreover, these injuries typically have devastating and irreversible long-term sequelae including physical, emotional, and socioeconomic consequences, they said.

They advocated prevention efforts similar to the Alpine Responsibility Code. Measures recommended in the code included:

Beginners should take lessons from a certified instructor.

Never ski or snowboard alone.

Exercise and stretch before skiing or snowboarding each day.

Stay on marked trails.

Wear helmets and other appropriate gear.

Quit before becoming overly tired.

The researchers reported no conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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